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  #1  
Old 10-24-2012
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Question Which Cancer?

A 61-year-old man with a past medical history of cancer presents with a 2-week history of constant and severe headaches. He also notes changes in his vision associated with the headaches. Physical examination shows a healing ecchymotic lesion on the right forearm, papilledema in the left eye, a right-sided pronator drift, and weakness of the right arm. The diagnosis of an intracranial hemorrhage is confirmed with CT of the head. Which of the following cancers is most likely to have resulted in this patient's presentation?

A Angiosarcoma
B Basal cell carcinoma
C Colorectal carcinoma
D Melanoma
E Prostate cancer
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Old 10-24-2012
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Default Dd

D..melanoma
metastasis to brain..lungs>breast>melanomaetc?
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Old 10-24-2012
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Default My asnwer D

nodular melano is frequent in men (vertical grow) and highly metastasic
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Old 10-24-2012
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Default my answer :)

D Melanoma
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Old 10-25-2012
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The correct answer is D. Intracranial metastases represent nearly half of all brain tumors, yet only 15% of tumors metastasize to the brain. Intracranial hemorrhages are a recognized but relatively uncommon complication of brain tumors and can result in intraparenchymal, subarachnoid, subdural, and epidural hematomas. Focal neurologic signs are frequently evident and are due to pressure exerted on the brain parenchyma. Renal cell carcinomas, choriocarcinomas, melanomas, retinoblastomas, and lung and breast cancers can result in hemorrhagic brain metastases. Since melanoma is a relatively frequent source of metastatic lesions to the brain (although less common than breast or lung carcinoma) and demonstrates a tendency to hemorrhage, melanoma is the correct answer in this case.

Answer A is incorrect. Angiosarcomas are malignant endothelial neoplasms that resemble hemangiomas. Although these tumors may bleed, angiosarcomas rarely metastasize, and only a few case reports exist of hemorrhage of cerebral metastasis from angiosarcoma.

Answer B is incorrect. Some cancers rarely metastasize to the brain; these include carcinomas of the oropharynx, esophagus, and prostate, as well as nonmelanoma skin cancers.

Answer C is incorrect. Colorectal carcinoma does metastasize to the brain (though less frequently than melanoma) but does not typically result in intracranial hemorrhage. Since colorectal carcinoma is less likely than melanoma to result in brain metastases and is not as likely to hemorrhage, melanoma is a better answer.

Answer E is incorrect. Carcinoma of the prostate almost never results in metastatic brain disease and therefore represents an extremely unlikely etiology for this patient's disease.
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Old 10-25-2012
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Quote:
Originally Posted by MedicalExaminer View Post
The correct answer is D. Intracranial metastases represent nearly half of all brain tumors, yet only 15% of tumors metastasize to the brain. Intracranial hemorrhages are a recognized but relatively uncommon complication of brain tumors and can result in intraparenchymal, subarachnoid, subdural, and epidural hematomas. Focal neurologic signs are frequently evident and are due to pressure exerted on the brain parenchyma. Renal cell carcinomas, choriocarcinomas, melanomas, retinoblastomas, and lung and breast cancers can result in hemorrhagic brain metastases. Since melanoma is a relatively frequent source of metastatic lesions to the brain (although less common than breast or lung carcinoma) and demonstrates a tendency to hemorrhage, melanoma is the correct answer in this case.

Answer A is incorrect. Angiosarcomas are malignant endothelial neoplasms that resemble hemangiomas. Although these tumors may bleed, angiosarcomas rarely metastasize, and only a few case reports exist of hemorrhage of cerebral metastasis from angiosarcoma.

Answer B is incorrect. Some cancers rarely metastasize to the brain; these include carcinomas of the oropharynx, esophagus, and prostate, as well as nonmelanoma skin cancers.

Answer C is incorrect. Colorectal carcinoma does metastasize to the brain (though less frequently than melanoma) but does not typically result in intracranial hemorrhage. Since colorectal carcinoma is less likely than melanoma to result in brain metastases and is not as likely to hemorrhage, melanoma is a better answer.

Answer E is incorrect. Carcinoma of the prostate almost never results in metastatic brain disease and therefore represents an extremely unlikely etiology for this patient's disease.
Had this q on exam 2 days ago. i went for melanoma too
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i go with melanoma
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